tag:blogger.com,1999:blog-26666124.post7356114585469848914..comments2015-03-03T11:57:53.323-05:00Comments on Shrink Rap: Transfering Care and Do You Have to Meet All Criteria for a Disorder to get Meds?Dinahnoreply@blogger.comBlogger16125tag:blogger.com,1999:blog-26666124.post-24576229273135830472011-05-28T04:35:44.661-04:002011-05-28T04:35:44.661-04:00This is interesting. I went back to my GP several ...This is interesting. I went back to my GP several times, and he was aware I was seeing the psychiatrist, had no problem with it, but the psychiatrist had no idea I was seeing the GP ... it was a bad system where I was, I saw a brand new psychiatrist every time and had to start from the very start (first episode, when, where, why, etc) <br /><br />So anyway, eventually my case got very boring, I was fine every single time ... and the psychiatrist had nothing to say, so they transfered me out. I find it interesting that it&#39;s rare... I started to find it a hassle to spend half an hour to hour every month or two to see the psychiatrist when I was completely fine, but I felt rude to decline.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-18708414173538943032011-05-27T09:42:47.234-04:002011-05-27T09:42:47.234-04:00Well I don&#39;t know who you are citing, but I do...Well I don&#39;t know who you are citing, but I doubt they have a license to prescribe medication. As a trained analyst who practices basically from a psycho-dynamic/insight oriented, family systems and substance abuse treatment perspective I can tell you that prescribing medication has everything to do with symptoms, family history, responses to other medications, and other subtle signs a patient exhibits. We don&#39;t have tests for &quot;chemicals in patients blood systems&quot; for psychiatric illness at present and there is not push to develop any.<br />However, the idea expressed that neurological diagnosis is more &quot;scientific&quot; or clear cut is a notion born of lack of experience. Though they have scans, MRIs, blood tests, lumbar punctures with which to test their patients, neurologists still sometime have difficulty diagnosing patients due to the nature of how much is unknown about the brain.Sideways Shrinknoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-76925119215833547652011-05-27T09:13:11.961-04:002011-05-27T09:13:11.961-04:00The summary paragraph:
&quot;But I don’t think we...The summary paragraph:<br /><br />&quot;But I don’t think we’ll ever be able to screen for psychiatric illness the same way a primary care doc might screen for, say, breast cancer or diabetes. To do so would redefine the entire concept of “mental” illness (perhaps making it “neurological” illness instead?). It also takes the person out of the picture. At the end of the day, it’s always the patient’s thoughts, words, and experiences that count. Ignoring those—and focusing instead on a chemical in the bloodstream—would be an unfortunate path to tread.&quot;Rob Lindemanhttp://natickpediatrics.netnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-34474794154297953412011-05-27T09:03:10.124-04:002011-05-27T09:03:10.124-04:00It would be helpful if you could offer a synopsis ...It would be helpful if you could offer a synopsis of that link, otherwise reader might not bother going to it.Sideways Shrinknoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-45632917150616136452011-05-27T08:48:05.651-04:002011-05-27T08:48:05.651-04:00Some thoughtful observations on the subject from a...Some thoughtful observations on the subject from a thoughtful psychiatrist:<br /><br />http://thoughtbroadcast.com/2011/05/27/biomarker-envy-ii-ethanolamine-phosphate/Rob Lindemanhttp://natickpediatrics.netnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-69822929882901762722011-05-27T06:06:48.448-04:002011-05-27T06:06:48.448-04:00In my area, primary care will only go to a certain...In my area, primary care will only go to a certain level of complexity with psych medications even when a patient is stable. And, depending on the severity of symptoms that have occurred during previous episodes, they will not manage even &quot;simple&quot; depression medications especially if the patient has insurance that a shrink will take/if the patient is willing to see a shrink and pay. Primary care here will not prescribe stimulants for adults. Maybe the family practice docs prescribe it for children?<br />I have read Rob Lindeman&#39;s posts on other web sites about psychiatry and it is reassuring to see the same basic idea repeated here: psychiatrists can&#39;t do brain biopsies/brain scans to have &quot;objective&quot; proof to back up their diagnoses therefore what we do is not actual medicine. Repetition is so comforting.Sideways Shrinknoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-2622839059508115142011-05-27T03:40:54.992-04:002011-05-27T03:40:54.992-04:00When someone comes to you having seen other psychi...When someone comes to you having seen other psychiatrist(s), do you ever request that patient&#39;s records from at least the most recent psychiatrist? I&#39;ve wondered, not that your response will reflect what mine does, but curious.<br /><br />Oh, and if you have the new patient write down their medicines history, what was tried, why, and why it was stopped or switched if it was. When I started with this one, she had me do this and it took me 45 min to an hour (all the new pt paperwork took me 3.5 hours to fill out in her waiting room, I shoulda gone home to do it). I also asked th e secretary to copy the medicines history I&#39;d written cause it&#39;s alot to remember. I need to update that history with another two pages of what has been done since then, since I have a strong feeling I&#39;ll eventually be seeing another psychiatrist . . . .Sarebearhttp://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-48161508700913561302011-05-27T00:46:44.387-04:002011-05-27T00:46:44.387-04:00Doctors don&#39;t transfer care. Patients do. For ...Doctors don&#39;t transfer care. Patients do. For a practicing psychiatrist diagnosis is just a small bump on the road to selecting the treatment that works.moviedochttp://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-69656623482874006102011-05-26T19:48:53.365-04:002011-05-26T19:48:53.365-04:00Dinah, we knew that is what you meant! We read Shr...Dinah, we knew that is what you meant! We read Shrink Rap. :)jessehttp://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-46772746680605786822011-05-26T19:16:00.570-04:002011-05-26T19:16:00.570-04:00Oops, I meant I do NOT do 7 minute sessions.Oops, I meant I do NOT do 7 minute sessions.Dinahhttp://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-29652392763989752282011-05-26T18:45:33.528-04:002011-05-26T18:45:33.528-04:00Anonymous, I disagree. What it means is spelled ou...Anonymous, I disagree. What it means is spelled out in the book that Dinah doesn&#39;t keep in the office, and to which I rarely refer. It is important though when you consider what communication was like in psychiatry before. I was trained in psychoanalysis and the diagnostic terms are virtually Greek to those not trained in it. There are many branches of psychology. Now, when I say major depression anyone with a DSM can at least get an idea of the symptoms observed. It is descriptive and behavioral rather than psychoanalytic.<br /><br />The definitions are readily available - just look on the web. So rather than keeping outsiders outside it makes the diagnoses understandable to the layman. Perhaps too much simplification to the extent subtlety is lost.<br /><br />Take for example diagnoses related to personality. Is the human personality truly able to be described in so few words?jessehttp://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-63713671786522412011-05-26T18:13:57.949-04:002011-05-26T18:13:57.949-04:00&quot;...we know when we use a diagnosis another p...&quot;...we know when we use a diagnosis another practitioner will understand what we mean&quot;. <br /><br />When I went to school we called that professional jargon. I think we still do. Others in the field will know what we mean and it is an effective mechanism for keeping outsiders outside.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-22262580759729651662011-05-26T12:50:16.987-04:002011-05-26T12:50:16.987-04:00The way Dinah does it describes accurately the way...The way Dinah does it describes accurately the way I do it. Flexibility based on experience. Autonomy for the patient to the extent it is safe. The DSM is exactly what she says, very useful for research and as a baseline in that we know when we use a diagnosis another practitioner will understand what we mean.jessehttp://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-14317806733406858762011-05-26T11:23:57.805-04:002011-05-26T11:23:57.805-04:00Interesting! I&#39;m glad to hear this - it confi...Interesting! I&#39;m glad to hear this - it confirms what I&#39;ve been assuming about the DSM (that it&#39;s not the end-all-be-all to clinical decisions in psychiatry). <br /><br />I only have 1 more psychiatry lecture left in medical school. I&#39;m glad there&#39;s blogs like this one where I can continue to hear cool stuff about psych.apotentialhttp://apotential.wordpress.com/noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-64696001854358714262011-05-26T07:54:21.383-04:002011-05-26T07:54:21.383-04:00Dinah, when all of the diagnostic criteria are sub...Dinah, when all of the diagnostic criteria are subjective, what does it matter if the young lady shows some or all of them?<br /><br />As your readers know well, the diagnosis of bi-polar disorder is made in children with the squishiest of diagnostic criteria, all of them subjective.Rob Lindemanhttp://natickpediatrics.netnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-14311626628395811522011-05-26T07:51:51.438-04:002011-05-26T07:51:51.438-04:00A college student might need to know that she is f...A college student might need to know that she is free to choose a different psychiatrist and she is free to visit her general practitioner and if the GP is willing to prescribe the medications for her, she can transfer the care herself. She does not need the psychiatrist&#39;s permission to leave care. Perhaps her parents are paying, but when I was in college I paid for all my own medical care so cost may be a factor. She could return to the psychiatrist if she needs additional support, but 7-minutes every 3 months sounds like very little support.Sunny CAhttp://www.blogger.com/profile/11451116932556227816noreply@blogger.com